Welcome to the April issue of Menopause, which is filled with information for the student of midlife women.
Lehmiller et al explored the role of masturbation in the relief of menopausal symptoms, predominantly psychological symptoms and sleep disturbances. In a sample of 1178 women (40-65 years old) one in five women noted that self-pleasure provided symptom relief.
Also in this issue, Hille et al wanted to learn more about sex toy use in older adults. In a survey of women over age 60, participants reported greater use of sex toys during masturbation than during sex with a partner. Those who reported frequent use of sex toys during partnered sex were more likely to report having an orgasm compared with women who had lower frequency of sex toy use.
In an outstanding editorial on both papers, Dr. Erika Kelley opened our eyes to the findings of each study. She highlighted that the study by Hille et al helped to remove the stigma of masturbation and sex toy use. Only 18% of women reported always experiencing an orgasm during partnered sex as compared to 45% of women always experiencing an orgasm through masturbation. Those who were more frequent sex toy users during masturbation were more likely to experience orgasms than less frequent users. Perhaps women users of sex toys in solo sexual activity are less distracted by a partner and can concentrate more on themselves. She made the point that there are different types of sex toys, and for older women with genitourinary symptoms of menopause, the penetrating toys may be uncomfortable, and external vibrators may be selected. She goes on to emphasize the importance of sexual health and provides a roadmap for moving forward.
Clinicians have felt that women who describe menopausal symptoms tend to have gastrointestinal symptoms (GI) as well. Nacar et al studied the relationship between them. In 212 women aged 45-55, the researchers identified a significant and positive relationship between menopausal and GI symptoms. For each point increase in the menopause symptom scale, the score in the GI symptoms was 1.02 points higher. In an excellent and thoughtful accompanying editorial, Dr. Brandilyn Peters informs us as to how menopause can affect the GI system. Estrogen and progesterone receptors are located throughout the GI tract modulating motility; for example, gastric emptying is accelerated in post-menopause. Menopause may influence gut permeability. Peters asks the question as to whether the symptoms share an underlying cause – estrogen decline – or do menopausal symptoms cause GI symptoms? From observational studies, we know that hormone therapy may increase the risks for irritable bowel syndrome, gastric motility disorders, and fecal incontinence. There is also a growing market of over-the-counter products for both disciplines and these products need careful studies.
This issue has a number of other research papers. Woods et al report on the Seattle Women's Health Study and found that aging was significantly and negatively related to anxiety, phobic anxiety, and interpersonal sensitivity.
In an interesting study, Dotson et al attempted to learn what may be a reason why some women respond to treatment for genitourinary symptoms of menopause and others do not.
Liss et al pointed out how teaching about menopause has been reduced. In response to the diminished teaching, they assessed the acceptability and effectiveness of an avatar-based education module for OB/GYN residents. The module was well received and improved learner engagement suggesting it to be a valuable strategy.
This month's Menopause Step-by-Step article focuses on the effect of the menopause transition on migraine, written by Dr. Carolyn Bernstein.
We hope you enjoy the issue!
Isaac Schiff, MD, CM
Editor-in-Chief
